ID

43249

Description

E2906 Abbreviated Comprehensive Geriatric Assessment Battery NCT01041703 Clofarabine or Daunorubicin Hydrochloride and Cytarabine Followed By Decitabine or Observation in Treating Older Patients With Newly Diagnosed Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7586A704-3044-A522-E040-BB89AD4359F8

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7586A704-3044-A522-E040-BB89AD4359F8

Keywords

Versions (5)
  1. 9/19/12 9/19/12 -
  2. 8/11/14 8/11/14 - Martin Dugas
  3. 1/8/15 1/8/15 - Martin Dugas
  4. 6/8/15 6/8/15 -
  5. 9/20/21 9/20/21 -
Uploaded on

September 20, 2021

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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E2906 Abbreviated Comprehensive Geriatric Assessment Battery NCT01041703

English

INSTRUCTIONS: Please complete this form according to the forms submission schedule. Submit original to the ECOG Coordinating Center. Keep a copy for your files

1 forms  
Header
Description

Header

DCI Name
Description

Generic drug form

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C3242750
NCI Thesaurus Property
C19464
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus ObjectClass-2
C25452
Registration Step (Place ID Label Here)
Description

Registration Number

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1514821
NCI Thesaurus ObjectClass
C25646
UMLS CUI-2
C0237753
NCI Thesaurus Property
C16154
NCI Thesaurus ValueDomain-2
C16154
Patient Initials (Last, First)
Description

Patient Initials

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
ECOG Protocol Number
Description

Protocol Number ECOG

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1512162
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25491
ECOG Protocol Number
Description

Protocol Number ECOG

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1512162
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25491
ECOG Patient ID
Description

Patient ID ECOG

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1512162
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25491
ECOG Patient ID
Description

Patient ID ECOG

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1512162
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25491
Participating Group Protocol Number
Description

Study Number Participating Group

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Participating Group Patient ID
Description

Trial subject ID Participating Group

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Institution/Affiliate
Description

Institution Name

Data type

text

Alias
NCI Thesaurus ObjectClass
C25454
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass-2
C21541
NCI Thesaurus Property
C25364
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ValueDomain-2
C21541
On Treatment
Description

On Treatment

On Treatment Report Period (Choose one)
Description

Cycle number

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS CUI-1
C2045829
NCI Thesaurus Property
C25214
NCI Thesaurus Property-2
C25616
NCI Thesaurus ObjectClass
C15368
Data amendment
Description

Data amendment

Please mark an 'X' if data have been amended. (Please circle amended items in red)
Description

Data amended

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
Date data amended (s M D Y)
Description

Data amended date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
UMLS CUI-2
C0011008
NCI Thesaurus Property
C25416
NCI Thesaurus ValueDomain-2
C25367
Assessment Date
Description

Assessment Date

Date of Assessment
Description

Assessment Date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C2985720
NCI Thesaurus ObjectClass
C25367
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus Property
C38000
Mini Mental Examination Section
Description

Mini Mental Examination Section

Total Score (ATTENTION AND CALCULATION 1 point for each correct answer Serial 7's: Have patient begin with 100 and count backward by 7. Stop after 5 answers. 1 point for each one correct. Or alternatively: spell 'world' backwards. Score by number of letters in correct order. LANGUAGE 1 point for each correct answer Show the patient the statement "Close your eyes" and have - him read and obey what it says. Have the patient write a sentence with a subject and verb. Have the patient copy the figure)
Description

Mini-MentalStatusExamAdministeredTotalCount

Data type

float

Alias
NCI Thesaurus ValueDomain
C25304
UMLS 2011AA ValueDomain
C0439810
NCI Thesaurus ValueDomain-2
C25463
UMLS 2011AA ValueDomain-2
C0750480
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
NCI Thesaurus ObjectClass
C74982
UMLS 2011AA ObjectClass
C0451306
Gds
Description

Gds

Do you feel that your life is empty
Description

PatientAnhedoniaAssessmentInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C3673
UMLS 2011AA Property
C0178417
Do you feel happy most of the time
Description

PatientHappinessAssessmentInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
C0018592
Do you often feel helpless
Description

PatientHopelessnessAssessmentInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C74531
UMLS 2011AA Property
C0150041
Do you feel pretty worthless the way you are now
Description

PatientWorthlessnessAssessmentInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C74535
UMLS 2011AA Property
C1821293
Adl
Description

Adl

Bathing (sponge bath, tub bath or shower)
Description

BathingPatientAssistanceAssessmentType

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Metathesaurus ObjectClass
C0150141
NCI Metathesaurus Property
C0018896
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Transfer
Description

TransferPatientAssistanceAssessmentType

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C48167
UMLS 2011AA ObjectClass-2
C1705822
NCI Metathesaurus Property
C0018896
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Continence
Description

IncontinencePatientAssistanceAssessmentType

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Metathesaurus ObjectClass
C0021167
NCI Metathesaurus Property
C0018896
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Can you go shopping for groceries
Description

ShoppingPatientAssistanceAssessmentType

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C81006
UMLS 2011AA ObjectClass-2
C0150768
NCI Metathesaurus Property
C0018896
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Can you prepare your own meals
Description

FoodPreparationPatientAssistanceAssessmentType

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C17604
UMLS 2011AA ObjectClass-2
C0920297
NCI Metathesaurus Property
C0018896
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Can you do your own housework
Description

HouseholdActivityPatientAssistanceAssessmentType

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C53291
UMLS 2011AA ObjectClass-2
C1708387
NCI Metathesaurus Property
C0018896
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Can you do your own laundry
Description

WashPatientAssistanceAssessmentType

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C65077
UMLS 2011AA ObjectClass-2
C0441648
NCI Metathesaurus Property
C0018896
NCI Thesaurus Property
C25367
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Section Ii - Social Support
Description

Section Ii - Social Support

Someone you can count on to listen to you when you need to talk
Description

QualityofLifePersonDiscussionAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25190
UMLS 2011AA Property
C0027361
NCI Thesaurus Property-2
C25367
NCI Thesaurus Property-3
C71323
UMLS 2011AA Property-2
C2584313
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Someone whose advice you really want
Description

QualityofLifePersonAdvisingAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25190
UMLS 2011AA Property
C0027361
NCI Thesaurus Property-2
C25367
NCI Thesaurus Property-3
C60731
UMLS 2011AA Property-2
C1828381
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Someone whose advice you really want
Description

QualityofLifePersonAdvisingAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25190
UMLS 2011AA Property
C0027361
NCI Thesaurus Property-2
C25367
NCI Thesaurus Property-3
C60731
UMLS 2011AA Property-2
C1828381
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Someone to share your most private worries and fears with
Description

QualityofLifePersonConfidenceAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25190
UMLS 2011AA Property
C0027361
NCI Thesaurus Property-2
C25367
NCI Thesaurus Property-3
C43367
UMLS 2011AA Property-2
C1704726
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Someone to share your most private worries and fears with
Description

QualityofLifePersonConfidenceAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25190
UMLS 2011AA Property
C0027361
NCI Thesaurus Property-2
C25367
NCI Thesaurus Property-3
C43367
UMLS 2011AA Property-2
C1704726
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Someone to turn to for suggestions about how to deal with a personal problem
Description

QualityofLifePersonInformationAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25190
UMLS 2011AA Property
C0027361
NCI Thesaurus Property-2
C25367
NCI Thesaurus Property-3
C48191
UMLS 2011AA Property-2
C1533716
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Someone to turn to for suggestions about how to deal with a personal problem
Description

QualityofLifePersonInformationAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25190
UMLS 2011AA Property
C0027361
NCI Thesaurus Property-2
C25367
NCI Thesaurus Property-3
C48191
UMLS 2011AA Property-2
C1533716
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Someone who understands your problems
Description

QualityofLifePersonProblemAppreciationAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25190
UMLS 2011AA Property
C0027361
NCI Thesaurus Property-2
C25367
NCI Thesaurus Property-3
C28020
UMLS 2011AA Property-2
C0033213
NCI Thesaurus Property-4
C72889
UMLS 2011AA Property-3
C2346843
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Section Ii - Social Support
Description

Section Ii - Social Support

Someone to help you if you were confined to bed
Description

QualityofLifePersonBedRestAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25190
UMLS 2011AA Property
C0027361
NCI Thesaurus Property-2
C25367
NCI Thesaurus Property-3
C45985
UMLS 2011AA Property-2
C0004910
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Someone to take you to the doctor if you needed it
Description

QualityofLifePersonPhysicianOfficeDeliveryAssessment

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25190
UMLS 2011AA Property
C0027361
NCI Thesaurus Property-2
C25367
NCI Thesaurus Property-3
C61560
NCI Thesaurus Property-4
C16988
UMLS 2011AA Property-2
C0031834
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Someone to prepare your meals if you were unable to do it yourself
Description

QualityofLifePersonFoodPreparationAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25190
UMLS 2011AA Property
C0027361
NCI Thesaurus Property-2
C25367
NCI Thesaurus Property-3
C62695
UMLS 2011AA Property-2
C0016452
NCI Thesaurus Property-4
C25625
UMLS 2011AA Property-3
C1521827
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Someone to help with daily chores if you were sick
Description

QualityofLifeHouseholdActivitySupportAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C37902
UMLS 2011AA Property
C1521721
NCI Thesaurus Property-3
C53291
UMLS 2011AA Property-2
C1708387
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Comorbidity Questionnaire
Description

Comorbidity Questionnaire

Have you ever had a heart attack
Description

PatientPriorMyocardialInfarctionInd-3

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C27996
UMLS 2011AA Property
C0027051
NCI Thesaurus Property-2
C25629
UMLS 2011AA Property-2
C0332152
Have you ever been treated for heart failure (You may have been short of breath and the doctor may have told you that you had fluid in your lungs or that your heart was not pumping well.)
Description

CongestiveHeartFailureHistoryInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C3080
UMLS 2011AA ObjectClass
C0018802
NCI Thesaurus Property
C18772
UMLS 2011AA Property
C0262926
Do you have other heart disease
Description

HeartInvolvedInd-3

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C12727
UMLS 2011AA ObjectClass
C0018787
NCI Thesaurus Property
C25547
Have you had an operation to unclog or bypass arteries in your legs
Description

OtherPeripheralArteryDiseasePresentInd-3

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C17649
UMLS 2011AA ObjectClass
C0205394
NCI Thesaurus ObjectClass-2
C2991
UMLS 2011AA ObjectClass-2
C0012634
NCI Thesaurus ObjectClass-3
C12372
UMLS 2011AA ObjectClass-3
C0003842
NCI Thesaurus ObjectClass-4
C25233
UMLS 2011AA ObjectClass-4
C0205100
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Have you had a stroke, cerebrovascular accident, blood clot or bleeding in the brain, or transient ischemic attack (TIA)
Description

PatientTransientIschemicAttackCerebrovascularAccidentPersonalMedicalHistoryInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C29867
UMLS 2011AA ObjectClass
C0679646
NCI Thesaurus Property
C50781
UMLS 2011AA Property
C0007787
NCI Thesaurus Property-2
C3390
UMLS 2011AA Property-2
C0038454
NCI Thesaurus Property-3
C18772
UMLS 2011AA Property-3
C0262926
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Do you have difficulty moving an arm or leg as a result of the stroke or cerebrovascular accident (If yes)
Description

PatientCerebrovascularAccidentMovementDifficultyPresentInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C3390
UMLS 2011AA Property-2
C0038454
NCI Thesaurus Property-3
C37994
UMLS 2011AA Property-3
C0026649
NCI Thesaurus Property-4
C62189
UMLS 2011AA Property-4
C1299586
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Do you have asthma
Description

AsthmaHistoryInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C18772
UMLS 2011AA Property
C0262926
NCI Thesaurus ObjectClass
C28397
UMLS 2011AA ObjectClass
C0004096
Do you take medicines for your asthma (If yes check one box)
Description

AsthmaMedicationPersonalMedicalHistoryIndicator

Data type

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus Property
C459
UMLS 2011AA Property
C0013227
NCI Thesaurus Property-2
C18772
UMLS 2011AA Property-2
C0262926
NCI Thesaurus ObjectClass
C28397
UMLS 2011AA ObjectClass
C0004096
Do you have emphysema, chronic bronchitis, or chronic obstructive lung disease
Description

DiseaseEmphysemaBronchitisPresentInd-3

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C2911
UMLS 2011AA Property-2
C0006277
NCI Thesaurus Property-3
C3348
UMLS 2011AA Property-3
C0034067
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Do you take medicines for your lung disease (If yes check one box)
Description

TherapeuticProcedureDiseaseEmphysemaBronchitisPresentIndicator

Data type

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass-2
C49236
UMLS 2011AA ObjectClass-2
C0087111
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C2911
UMLS 2011AA Property-2
C0006277
NCI Thesaurus Property-3
C3348
UMLS 2011AA Property-3
C0034067
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
Comorbidity Questionnaire1
Description

Comorbidity Questionnaire1

Do you have stomach ulcers, or peptic ulcer disease
Description

DiseaseStomachPresentInd-3

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C12391
UMLS 2011AA Property-2
C0038351
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
Do you have diabetes (high blood sugar)
Description

DiabetesMellitusDiseasesandDisordersMedicationBaselineUseInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass-2
C2985
UMLS 2011AA ObjectClass-2
C0011849
NCI Thesaurus ObjectClass-3
C459
UMLS 2011AA ObjectClass-3
C0013227
NCI Thesaurus Property
C25213
UMLS 2011AA Property
C1442488
NCI Thesaurus Property-2
C25340
UMLS 2011AA Property-2
C0457083
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
How is it treated (If yes check one box)
Description

DiabetesMellitusCurrentTherapeuticProcedureType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C25471
UMLS 2011AA Property
C0521116
NCI Thesaurus ObjectClass
C2985
UMLS 2011AA ObjectClass
C0011849
NCI Thesaurus Property-2
C49236
UMLS 2011AA Property-2
C0087111
Has the diabetes caused any of the following problems (If yes)
Description

PatientDiabetesOrganComplicationPersonalMedicalHistoryType

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C2985
UMLS 2011AA Property
C0011849
NCI Thesaurus Property-2
C2959
UMLS 2011AA Property-2
C0009566
NCI Thesaurus Property-3
C13018
UMLS 2011AA Property-3
C0178784
NCI Thesaurus Property-4
C18772
UMLS 2011AA Property-4
C0262926
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Have you ever had the following problems with your kidneys
Description

KidneyDiseasePresentType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ObjectClass
C12415
UMLS 2011AA ObjectClass
C0022646
NCI Thesaurus ObjectClass-2
C2991
UMLS 2011AA ObjectClass-2
C0012634
Do you have arthritis
Description

PatientArthritisPersonalMedicalHistoryInd-3

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C2883
UMLS 2011AA Property
C0003864
NCI Thesaurus Property-2
C18772
UMLS 2011AA Property-2
C0262926
Do you take medications for it regularly (If yes)
Description

ConcomitantMedicationUseInd-3

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C459
UMLS 2011AA ObjectClass
C0013227
NCI Thesaurus ObjectClass-2
C25730
UMLS 2011AA ObjectClass-2
C0521115
NCI Thesaurus Property
C25340
UMLS 2011AA Property
C0457083
Do you have any of the following conditions
Description

ConcomitantDiseasePersonalMedicalHistoryType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass-2
C25730
UMLS 2011AA ObjectClass-2
C0521115
NCI Thesaurus Property
C18772
UMLS 2011AA Property
C0262926
How often do you see your dentist
Description

PersonDentistVisitType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C52654
UMLS 2011AA Property
C0011441
NCI Thesaurus Property-2
C25716
UMLS 2011AA Property-2
C0545082
Please list any other health problems you have in the space below
Description

ChronicDiseaseDiagnosisSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass-2
C14141
UMLS 2011AA ObjectClass-2
C0205191
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ValueDomain-2
C17649
UMLS 2011AA ValueDomain-2
C0205394
Medications/sexual Function
Description

Medications/sexual Function

On average, how many prescription medicines do you take each day
Description

ConcomitantPrescriptionMedicationUseNumber

Data type

text

Alias
NCI Thesaurus ObjectClass
C459
UMLS 2011AA ObjectClass
C0013227
NCI Thesaurus ObjectClass-2
C28180
UMLS 2011AA ObjectClass-2
C1521941
NCI Thesaurus ObjectClass-3
C25730
UMLS 2011AA ObjectClass-3
C0521115
NCI Thesaurus Property
C25340
UMLS 2011AA Property
C0457083
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
On average, how many non-prescription medicines (over-the-counter) do you take each day
Description

ConcomitantMedicationUseNumber

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C459
UMLS 2011AA ObjectClass
C0013227
NCI Thesaurus ObjectClass-2
C25730
UMLS 2011AA ObjectClass-2
C0521115
NCI Thesaurus Property
C25340
UMLS 2011AA Property
C0457083
During the last 4 weeks, did you have sexual intercourse
Description

Sexual activity

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS CUI-1
C0036864
NCI Thesaurus ObjectClass-2
C17127
NCI Thesaurus Property
C25367
NCI Thesaurus Property-2
C25275
NCI Thesaurus Property-3
C72881
NCI Thesaurus ValueDomain
C25664
Over the past 4 weeks, how would you rate your level of sexual desire
Description

SexBehaviorQualityofLifeOverallSatisfactionAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C17047
UMLS 2011AA ObjectClass
C0518214
NCI Thesaurus ObjectClass-2
C17127
UMLS 2011AA ObjectClass-2
C0036864
NCI Thesaurus Property
C25605
UMLS 2011AA Property
C1561607
NCI Thesaurus Property-2
C25367
NCI Thesaurus Property-3
C62185
UMLS 2011AA Property-2
C0242428
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Weight
Description

Weight

What is your usual weight
Description

PatientNormalWeightMeasurement

Data type

float

Measurement units
  • Kg
Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C14165
UMLS 2011AA Property
C0205307
NCI Thesaurus Property-2
C25208
UMLS 2011AA Property-2
C0043100
Kg
How much weight have you lost in the past 6 months
Description

PatientWeightLossMeasurement

Data type

float

Measurement units
  • Kg
Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C3445
UMLS 2011AA Property
C1262477
Kg
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Similar models

INSTRUCTIONS: Please complete this form according to the forms submission schedule. Submit original to the ECOG Coordinating Center. Keep a copy for your files

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
Generic drug form
Item
DCI Name
text
C25191 (NCI Thesaurus ValueDomain)
C3242750 (UMLS CUI-1)
C19464 (NCI Thesaurus Property)
C25474 (NCI Thesaurus ObjectClass)
C25452 (NCI Thesaurus ObjectClass-2)
Registration Number
Item
Registration Step (Place ID Label Here)
text
C25337 (NCI Thesaurus ValueDomain)
C1514821 (UMLS CUI-1)
C25646 (NCI Thesaurus ObjectClass)
C0237753 (UMLS CUI-2)
C16154 (NCI Thesaurus Property)
C16154 (NCI Thesaurus ValueDomain-2)
Patient Initials
Item
Patient Initials (Last, First)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Protocol Number ECOG
Item
ECOG Protocol Number
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
Protocol Number ECOG
Item
ECOG Protocol Number
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
Patient ID ECOG
Item
ECOG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
Patient ID ECOG
Item
ECOG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
Study Number Participating Group
Item
Participating Group Protocol Number
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Trial subject ID Participating Group
Item
Participating Group Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Institution Name
Item
Institution/Affiliate
text
C25454 (NCI Thesaurus ObjectClass)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
Item Group
On Treatment
Item
On Treatment Report Period (Choose one)
text
C25284 (NCI Thesaurus ValueDomain)
C2045829 (UMLS CUI-1)
C25214 (NCI Thesaurus Property)
C25616 (NCI Thesaurus Property-2)
C15368 (NCI Thesaurus ObjectClass)
CL.1
Code List
On Treatment Report Period (Choose one)
CL Item
Baseline Step 1 (Baseline Step 1)
Item Group
Data amendment
Data amended
Item
Please mark an 'X' if data have been amended. (Please circle amended items in red)
text
C25704 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Data amended date
Item
Date data amended (s M D Y)
date
C25164 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C0011008 (UMLS CUI-2)
C25416 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
Item Group
Assessment Date
Assessment Date
Item
Date of Assessment
date
C25164 (NCI Thesaurus ValueDomain)
C2985720 (UMLS CUI-1)
C25367 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus ValueDomain-2)
C38000 (NCI Thesaurus Property)
Item Group
Mini Mental Examination Section
Mini-MentalStatusExamAdministeredTotalCount
Item
Total Score (ATTENTION AND CALCULATION 1 point for each correct answer Serial 7's: Have patient begin with 100 and count backward by 7. Stop after 5 answers. 1 point for each one correct. Or alternatively: spell 'world' backwards. Score by number of letters in correct order. LANGUAGE 1 point for each correct answer Show the patient the statement "Close your eyes" and have - him read and obey what it says. Have the patient write a sentence with a subject and verb. Have the patient copy the figure)
float
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C74982 (NCI Thesaurus ObjectClass)
C0451306 (UMLS 2011AA ObjectClass)
Item Group
Gds
PatientAnhedoniaAssessmentInd-2
Item
Do you feel that your life is empty
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C3673 (NCI Thesaurus Property-2)
C0178417 (UMLS 2011AA Property)
PatientHappinessAssessmentInd-2
Item
Do you feel happy most of the time
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0018592 (NCI Metathesaurus Property)
PatientHopelessnessAssessmentInd-2
Item
Do you often feel helpless
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C74531 (NCI Thesaurus Property-2)
C0150041 (UMLS 2011AA Property)
PatientWorthlessnessAssessmentInd-2
Item
Do you feel pretty worthless the way you are now
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C74535 (NCI Thesaurus Property-2)
C1821293 (UMLS 2011AA Property)
Item Group
Adl
Item
Bathing (sponge bath, tub bath or shower)
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0150141 (NCI Metathesaurus ObjectClass)
C0018896 (NCI Metathesaurus Property)
C25367 (NCI Thesaurus Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.6
Code List
Bathing (sponge bath, tub bath or shower)
CL Item
I Receive No Assistance (I receive no assistance)
CL Item
I Receive Assistance In Bathing Only One Part Of The Body (I receive assistance in bathing only one part of the body)
CL Item
I Receive Assistance In Bathing More Than One Part Of The Body (I receive assistance in bathing more than one part of the body)
Item
Transfer
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C48167 (NCI Thesaurus ObjectClass-2)
C1705822 (UMLS 2011AA ObjectClass-2)
C0018896 (NCI Metathesaurus Property)
C25367 (NCI Thesaurus Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.7
Code List
Transfer
CL Item
I Am Able To Move Into And Out Of Bed As Well As Into And Out Of Chair Without Assistance (I am able to move into and out of bed as well as into and out of chair without assistance)
CL Item
I Am Able To Move Into And Out Of Bed Or Chair With Assistance (I am able to move into and out of bed or chair with assistance)
CL Item
I Am Not Able To Get Out Of Bed (I am not able to get out of bed)
Item
Continence
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C0021167 (NCI Metathesaurus ObjectClass)
C0018896 (NCI Metathesaurus Property)
C25367 (NCI Thesaurus Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.8
Code List
Continence
CL Item
I Am Able To Control Urination And Bowel Movement Completely By Myself (I am able to control urination and bowel movement completely by myself)
CL Item
I Have Occasional Accidents (I have occasional accidents)
CL Item
I Need Someone To Help Me Keep Control Of Urination Or Bowel Movement Or A Catheter Is Used Or I Am Unable To Hold My Urine Or Bowel Movements (I need someone to help me keep control of urination or bowel movement OR a catheter is used OR I am unable to hold my urine or bowel movements)
Item
Can you go shopping for groceries
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C81006 (NCI Thesaurus ObjectClass-2)
C0150768 (UMLS 2011AA ObjectClass-2)
C0018896 (NCI Metathesaurus Property)
C25367 (NCI Thesaurus Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.9
Code List
Can you go shopping for groceries
CL Item
Without Help (Without help)
CL Item
With Some Help (With some help)
CL Item
I Am Completely Unable To Do Any Shopping (I am completely unable to do any shopping)
Item
Can you prepare your own meals
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17604 (NCI Thesaurus ObjectClass-2)
C0920297 (UMLS 2011AA ObjectClass-2)
C0018896 (NCI Metathesaurus Property)
C25367 (NCI Thesaurus Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.10
Code List
Can you prepare your own meals
CL Item
Without Help (Without help)
CL Item
With Some Help (With some help)
CL Item
I Am Completely Unable To Prepare Any Meals (I am completely unable to prepare any meals)
Item
Can you do your own housework
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C53291 (NCI Thesaurus ObjectClass-2)
C1708387 (UMLS 2011AA ObjectClass-2)
C0018896 (NCI Metathesaurus Property)
C25367 (NCI Thesaurus Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.11
Code List
Can you do your own housework
CL Item
Without Help (Without help)
CL Item
With Help (With help)
CL Item
I Am Completely Unable To Do Any Housework (I am completely unable to do any housework)
Item
Can you do your own laundry
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C65077 (NCI Thesaurus ObjectClass-2)
C0441648 (UMLS 2011AA ObjectClass-2)
C0018896 (NCI Metathesaurus Property)
C25367 (NCI Thesaurus Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.12
Code List
Can you do your own laundry
CL Item
Without Help (Without help)
CL Item
With Help (With help)
CL Item
I Am Completely Unable To Do Any Laundry At All (I am completely unable to do any laundry at all)
Item
Someone you can count on to listen to you when you need to talk
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25190 (NCI Thesaurus Property)
C0027361 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C71323 (NCI Thesaurus Property-3)
C2584313 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.13
Code List
Someone you can count on to listen to you when you need to talk
CL Item
A Little Of The Time (A little of the time)
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
None Of The Time (None of the time)
CL Item
Some Of The Time (Some of the time)
Item
Someone whose advice you really want
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25190 (NCI Thesaurus Property)
C0027361 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C60731 (NCI Thesaurus Property-3)
C1828381 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.17
Code List
Someone whose advice you really want
CL Item
A Little Of The Time (A little of the time)
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
None Of The Time (None of the time)
CL Item
Some Of The Time (Some of the time)
Item
Someone whose advice you really want
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25190 (NCI Thesaurus Property)
C0027361 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C60731 (NCI Thesaurus Property-3)
C1828381 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.17
Code List
Someone whose advice you really want
CL Item
A Little Of The Time (A little of the time)
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
None Of The Time (None of the time)
CL Item
Some Of The Time (Some of the time)
Item
Someone to share your most private worries and fears with
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25190 (NCI Thesaurus Property)
C0027361 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C43367 (NCI Thesaurus Property-3)
C1704726 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.18
Code List
Someone to share your most private worries and fears with
CL Item
A Little Of The Time (A little of the time)
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
None Of The Time (None of the time)
CL Item
Some Of The Time (Some of the time)
Item
Someone to share your most private worries and fears with
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25190 (NCI Thesaurus Property)
C0027361 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C43367 (NCI Thesaurus Property-3)
C1704726 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.18
Code List
Someone to share your most private worries and fears with
CL Item
A Little Of The Time (A little of the time)
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
None Of The Time (None of the time)
CL Item
Some Of The Time (Some of the time)
Item
Someone to turn to for suggestions about how to deal with a personal problem
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25190 (NCI Thesaurus Property)
C0027361 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C48191 (NCI Thesaurus Property-3)
C1533716 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.19
Code List
Someone to turn to for suggestions about how to deal with a personal problem
CL Item
A Little Of The Time (A little of the time)
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
None Of The Time (None of the time)
CL Item
Some Of The Time (Some of the time)
Item
Someone to turn to for suggestions about how to deal with a personal problem
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25190 (NCI Thesaurus Property)
C0027361 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C48191 (NCI Thesaurus Property-3)
C1533716 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.19
Code List
Someone to turn to for suggestions about how to deal with a personal problem
CL Item
A Little Of The Time (A little of the time)
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
None Of The Time (None of the time)
CL Item
Some Of The Time (Some of the time)
Item
Someone who understands your problems
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25190 (NCI Thesaurus Property)
C0027361 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C28020 (NCI Thesaurus Property-3)
C0033213 (UMLS 2011AA Property-2)
C72889 (NCI Thesaurus Property-4)
C2346843 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.20
Code List
Someone who understands your problems
CL Item
A Little Of The Time (A little of the time)
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
None Of The Time (None of the time)
CL Item
Some Of The Time (Some of the time)
Item Group
Section Ii - Social Support
Item
Someone to help you if you were confined to bed
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25190 (NCI Thesaurus Property)
C0027361 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C45985 (NCI Thesaurus Property-3)
C0004910 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.21
Code List
Someone to help you if you were confined to bed
CL Item
A Little Of The Time (A little of the time)
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
None Of The Time (None of the time)
CL Item
Some Of The Time (Some of the time)
Item
Someone to take you to the doctor if you needed it
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25190 (NCI Thesaurus Property)
C0027361 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C61560 (NCI Thesaurus Property-3)
C16988 (NCI Thesaurus Property-4)
C0031834 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.22
Code List
Someone to take you to the doctor if you needed it
CL Item
A Little Of The Time (A little of the time)
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
None Of The Time (None of the time)
CL Item
Some Of The Time (Some of the time)
Item
Someone to prepare your meals if you were unable to do it yourself
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25190 (NCI Thesaurus Property)
C0027361 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C62695 (NCI Thesaurus Property-3)
C0016452 (UMLS 2011AA Property-2)
C25625 (NCI Thesaurus Property-4)
C1521827 (UMLS 2011AA Property-3)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.23
Code List
Someone to prepare your meals if you were unable to do it yourself
CL Item
A Little Of The Time (A little of the time)
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
None Of The Time (None of the time)
CL Item
Some Of The Time (Some of the time)
Item
Someone to help with daily chores if you were sick
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C37902 (NCI Thesaurus Property-2)
C1521721 (UMLS 2011AA Property)
C53291 (NCI Thesaurus Property-3)
C1708387 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.24
Code List
Someone to help with daily chores if you were sick
CL Item
A Little Of The Time (A little of the time)
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
None Of The Time (None of the time)
CL Item
Some Of The Time (Some of the time)
Item Group
Comorbidity Questionnaire
PatientPriorMyocardialInfarctionInd-3
Item
Have you ever had a heart attack
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C27996 (NCI Thesaurus Property)
C0027051 (UMLS 2011AA Property)
C25629 (NCI Thesaurus Property-2)
C0332152 (UMLS 2011AA Property-2)
CongestiveHeartFailureHistoryInd-2
Item
Have you ever been treated for heart failure (You may have been short of breath and the doctor may have told you that you had fluid in your lungs or that your heart was not pumping well.)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C3080 (NCI Thesaurus ObjectClass)
C0018802 (UMLS 2011AA ObjectClass)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
HeartInvolvedInd-3
Item
Do you have other heart disease
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C12727 (NCI Thesaurus ObjectClass)
C0018787 (UMLS 2011AA ObjectClass)
C25547 (NCI Thesaurus Property)
OtherPeripheralArteryDiseasePresentInd-3
Item
Have you had an operation to unclog or bypass arteries in your legs
boolean
C17649 (NCI Thesaurus ObjectClass)
C0205394 (UMLS 2011AA ObjectClass)
C2991 (NCI Thesaurus ObjectClass-2)
C0012634 (UMLS 2011AA ObjectClass-2)
C12372 (NCI Thesaurus ObjectClass-3)
C0003842 (UMLS 2011AA ObjectClass-3)
C25233 (NCI Thesaurus ObjectClass-4)
C0205100 (UMLS 2011AA ObjectClass-4)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
PatientTransientIschemicAttackCerebrovascularAccidentPersonalMedicalHistoryInd-2
Item
Have you had a stroke, cerebrovascular accident, blood clot or bleeding in the brain, or transient ischemic attack (TIA)
boolean
C29867 (NCI Thesaurus ObjectClass)
C0679646 (UMLS 2011AA ObjectClass)
C50781 (NCI Thesaurus Property)
C0007787 (UMLS 2011AA Property)
C3390 (NCI Thesaurus Property-2)
C0038454 (UMLS 2011AA Property-2)
C18772 (NCI Thesaurus Property-3)
C0262926 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PatientCerebrovascularAccidentMovementDifficultyPresentInd-2
Item
Do you have difficulty moving an arm or leg as a result of the stroke or cerebrovascular accident (If yes)
boolean
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C3390 (NCI Thesaurus Property-2)
C0038454 (UMLS 2011AA Property-2)
C37994 (NCI Thesaurus Property-3)
C0026649 (UMLS 2011AA Property-3)
C62189 (NCI Thesaurus Property-4)
C1299586 (UMLS 2011AA Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
AsthmaHistoryInd-2
Item
Do you have asthma
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C28397 (NCI Thesaurus ObjectClass)
C0004096 (UMLS 2011AA ObjectClass)
Item
Do you take medicines for your asthma (If yes check one box)
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C459 (NCI Thesaurus Property)
C0013227 (UMLS 2011AA Property)
C18772 (NCI Thesaurus Property-2)
C0262926 (UMLS 2011AA Property-2)
C28397 (NCI Thesaurus ObjectClass)
C0004096 (UMLS 2011AA ObjectClass)
CL.32
Code List
Do you take medicines for your asthma (If yes check one box)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes, Only With Flare-ups Of My Asthma (Yes, only with flare-ups of my asthma)
CL Item
Yes, I Take Medicines Regularly Even When I'm Not Having A Flare-up (Yes, I take medicines regularly even when I'm not having a flare-up)
DiseaseEmphysemaBronchitisPresentInd-3
Item
Do you have emphysema, chronic bronchitis, or chronic obstructive lung disease
boolean
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C2911 (NCI Thesaurus Property-2)
C0006277 (UMLS 2011AA Property-2)
C3348 (NCI Thesaurus Property-3)
C0034067 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
Item
Do you take medicines for your lung disease (If yes check one box)
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C49236 (NCI Thesaurus ObjectClass-2)
C0087111 (UMLS 2011AA ObjectClass-2)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C2911 (NCI Thesaurus Property-2)
C0006277 (UMLS 2011AA Property-2)
C3348 (NCI Thesaurus Property-3)
C0034067 (UMLS 2011AA Property-3)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
CL.34
Code List
Do you take medicines for your lung disease (If yes check one box)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes, Only With Flare-ups Of My Lung Disease (Yes, only with flare-ups of my lung disease)
CL Item
Yes, I Take Medicines Regularly Even When I'm Not Having A Flare-up (Yes, I take medicines regularly even when I'm not having a flare-up)
Item Group
Comorbidity Questionnaire1
DiseaseStomachPresentInd-3
Item
Do you have stomach ulcers, or peptic ulcer disease
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C12391 (NCI Thesaurus Property-2)
C0038351 (UMLS 2011AA Property-2)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
DiabetesMellitusDiseasesandDisordersMedicationBaselineUseInd-2
Item
Do you have diabetes (high blood sugar)
boolean
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C2985 (NCI Thesaurus ObjectClass-2)
C0011849 (UMLS 2011AA ObjectClass-2)
C459 (NCI Thesaurus ObjectClass-3)
C0013227 (UMLS 2011AA ObjectClass-3)
C25213 (NCI Thesaurus Property)
C1442488 (UMLS 2011AA Property)
C25340 (NCI Thesaurus Property-2)
C0457083 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
How is it treated (If yes check one box)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C2985 (NCI Thesaurus ObjectClass)
C0011849 (UMLS 2011AA ObjectClass)
C49236 (NCI Thesaurus Property-2)
C0087111 (UMLS 2011AA Property-2)
CL.37
Code List
How is it treated (If yes check one box)
CL Item
Treated By Modifying My Diet (Treated by modifying my diet)
CL Item
Treated By Medications Taken By Mouth (Treated by medications taken by mouth)
CL Item
Treated By Insulin Injections (Treated by insulin injections)
Item
Has the diabetes caused any of the following problems (If yes)
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C2985 (NCI Thesaurus Property)
C0011849 (UMLS 2011AA Property)
C2959 (NCI Thesaurus Property-2)
C0009566 (UMLS 2011AA Property-2)
C13018 (NCI Thesaurus Property-3)
C0178784 (UMLS 2011AA Property-3)
C18772 (NCI Thesaurus Property-4)
C0262926 (UMLS 2011AA Property-4)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.38
Code List
Has the diabetes caused any of the following problems (If yes)
CL Item
Problems With Your Kidneys (Problems with your kidneys)
CL Item
Problems With Your Eyes, Treated By An Ophthamologist (Problems with your eyes, treated by an ophthamologist)
CL Item
Problems With Numbness Or Tingling In Your Feet Or Legs (Problems with numbness or tingling in your feet or legs)
Item
Have you ever had the following problems with your kidneys
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C12415 (NCI Thesaurus ObjectClass)
C0022646 (UMLS 2011AA ObjectClass)
C2991 (NCI Thesaurus ObjectClass-2)
C0012634 (UMLS 2011AA ObjectClass-2)
CL.39
Code List
Have you ever had the following problems with your kidneys
CL Item
Poor Kidney Function (Poor kidney function)
CL Item
Have Used Dialysis (Have used dialysis)
CL Item
Have Received Kidney Transplantation (Have received kidney transplantation)
PatientArthritisPersonalMedicalHistoryInd-3
Item
Do you have arthritis
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C2883 (NCI Thesaurus Property)
C0003864 (UMLS 2011AA Property)
C18772 (NCI Thesaurus Property-2)
C0262926 (UMLS 2011AA Property-2)
ConcomitantMedicationUseInd-3
Item
Do you take medications for it regularly (If yes)
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C459 (NCI Thesaurus ObjectClass)
C0013227 (UMLS 2011AA ObjectClass)
C25730 (NCI Thesaurus ObjectClass-2)
C0521115 (UMLS 2011AA ObjectClass-2)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
Item
Do you have any of the following conditions
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25730 (NCI Thesaurus ObjectClass-2)
C0521115 (UMLS 2011AA ObjectClass-2)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
CL.42
Code List
Do you have any of the following conditions
CL Item
Alzheimer's Disease, Or Another Form Of Dementia (Alzheimer's Disease, or another form of dementia)
CL Item
Cirrhosis, Hepatitis, Or Serious Liver Disease (Cirrhosis, hepatitis, or serious liver disease)
CL Item
Anemia (Anemia)
C2869 (NCI Thesaurus)
C0002871 (UMLS 2011AA)
CL Item
Depression (Depression)
C2982 (NCI Thesaurus)
C0011570 (UMLS 2011AA)
CL Item
Chronic Sinus Infections (Chronic sinus infections)
CL Item
Chronic Back Pain (Chronic back pain)
CL Item
Osteoporosis (Osteoporosis)
C3298 (NCI Thesaurus)
C0029456 (UMLS 2011AA)
CL Item
Dental Problems (Dental Problems)
CL Item
Cancer (Cancer)
Item
How often do you see your dentist
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C52654 (NCI Thesaurus Property)
C0011441 (UMLS 2011AA Property)
C25716 (NCI Thesaurus Property-2)
C0545082 (UMLS 2011AA Property-2)
CL.43
Code List
How often do you see your dentist
CL Item
Every 6-12 Months (Every 6-12 months)
CL Item
Every 1-2 Years (Every 1-2 years)
CL Item
I Don't See A Dentist (I don't see a dentist)
ChronicDiseaseDiagnosisSpecify
Item
Please list any other health problems you have in the space below
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C14141 (NCI Thesaurus ObjectClass-2)
C0205191 (UMLS 2011AA ObjectClass-2)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus ValueDomain-2)
C0205394 (UMLS 2011AA ValueDomain-2)
Item Group
Medications/sexual Function
Item
On average, how many prescription medicines do you take each day
text
C459 (NCI Thesaurus ObjectClass)
C0013227 (UMLS 2011AA ObjectClass)
C28180 (NCI Thesaurus ObjectClass-2)
C1521941 (UMLS 2011AA ObjectClass-2)
C25730 (NCI Thesaurus ObjectClass-3)
C0521115 (UMLS 2011AA ObjectClass-3)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
CL.44
Code List
On average, how many prescription medicines do you take each day
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
1-3 (1-3)
CL Item
4-6 (4-6)
CL Item
7-10 (7-10)
CL Item
More Than 10 (More than 10)
Item
On average, how many non-prescription medicines (over-the-counter) do you take each day
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C459 (NCI Thesaurus ObjectClass)
C0013227 (UMLS 2011AA ObjectClass)
C25730 (NCI Thesaurus ObjectClass-2)
C0521115 (UMLS 2011AA ObjectClass-2)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
CL.45
Code List
On average, how many non-prescription medicines (over-the-counter) do you take each day
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
1-3 (1-3)
CL Item
4-6 (4-6)
CL Item
7-10 (7-10)
CL Item
More Than 10 (More than 10)
Item
During the last 4 weeks, did you have sexual intercourse
text
C17047 (NCI Thesaurus ObjectClass)
C0036864 (UMLS CUI-1)
C17127 (NCI Thesaurus ObjectClass-2)
C25367 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property-2)
C72881 (NCI Thesaurus Property-3)
C25664 (NCI Thesaurus ValueDomain)
CL.46
Code List
During the last 4 weeks, did you have sexual intercourse
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes, Once (Yes, once)
CL Item
Yes, More Than Once (Yes, more than once)
Item
Over the past 4 weeks, how would you rate your level of sexual desire
text
C17047 (NCI Thesaurus ObjectClass)
C0518214 (UMLS 2011AA ObjectClass)
C17127 (NCI Thesaurus ObjectClass-2)
C0036864 (UMLS 2011AA ObjectClass-2)
C25605 (NCI Thesaurus Property)
C1561607 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C62185 (NCI Thesaurus Property-3)
C0242428 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.47
Code List
Over the past 4 weeks, how would you rate your level of sexual desire
CL Item
Very Low/none At All (Very low/none at all)
CL Item
Low (Low)
C54722 (NCI Thesaurus)
C0205251 (UMLS 2011AA)
CL Item
Moderation (Moderate)
C61376 (NCI Thesaurus)
C1881878 (UMLS 2011AA)
CL Item
High (High)
C25227 (NCI Thesaurus)
C0205250 (UMLS 2011AA)
CL Item
Very High (Very high)
Item Group
Weight
PatientNormalWeightMeasurement
Item
What is your usual weight
float
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C14165 (NCI Thesaurus Property)
C0205307 (UMLS 2011AA Property)
C25208 (NCI Thesaurus Property-2)
C0043100 (UMLS 2011AA Property-2)
PatientWeightLossMeasurement
Item
How much weight have you lost in the past 6 months
float
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C3445 (NCI Thesaurus Property)
C1262477 (UMLS 2011AA Property)
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